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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 304 E WEBER AVE-3°b FL 68- <br /> -STOCKTON CA%202 - (209)43420 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT i <br /> "NQEFUNDABLE 17 <br /> PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> CITY/7JP- •� �7' ,, <br /> FJOIRADDRESSyAPN? T] PARCEL SIZE A�SS STREET 6 PHONENER NAME t-OCfl'Y/$TAT£/Z!PNER ADDRESS 1 (� r' PHONE �� O <br /> ' Q d/' c r�' <br /> CONTRACTOR '3 <br /> --- CITY/STA7T'JLtp <br /> CONTRACTOR ADDRESS - <br /> NUMBER E%PIRATION DATE <br /> LICENSE -42 -36 OTHER __ - y <br /> ft GEOGRAPHICAL INFORMATION: C04"nales X <br /> WATER TABLE DEPTH: <br /> BUILDING PEwtitIT# — LAND USE APPLICATION# --- <br /> ❑ FERC TEST # DlALTERNATWE <br /> NEW INbTALI ATI Nt ❑ REPAIR/ADDFTION <br /> TYPE OF WORK: DESTRU !_ <br /> L) REPLACEMENT ❑ OTHER to <br /> El COMMERCIAL <br /> i INSTALLATION WILL SERVE: ❑ RESIDENCE NUMBER OF BEDROOMS: NU BER OF EMPLOYEES: <br /> NUMBER OF LIVING UNITS: <br /> CAPACI <br /> 13 SEPTIC T E <br /> SEPTIC TANK 7YPEIMFG�_ - C C v. T1 5 <br /> ❑ GREASE TRAP TYWMFG fl ft <br /> ft OUNDATIOPefs4m"Ma17e e. jy <br /> Ll PKC TX PLANT DISTANCE TO NEAREST: WELL_ `-`J E M) <br /> ❑ LIFT STATION SIZE TYPE OF PUMP w r <br /> #,h d; .IJ(on _R <br /> ❑ "LEACH LINES ❑ LEACHING CHAMBERS R p RTY LINE R <br /> WELL ft FOUNDATION <br /> - DISTANCE TO NEAREST R EPTH ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft ft <br /> FOUND R PROPERTY LINE <br /> i <br /> DISTANCE To NEAREST WELL ft DEPTH ft <br /> L3 MOUNDED LENGTH MOUNDED WIDTH {t PROPERTY LINE R <br /> R <br /> DISTANCE 70 NEAREST WELL R FOUNDATION ft _DEPTH_ <br /> ❑ SUMPS WIDTH----.----ft LENGTH "—ft <br /> R FOUNDATION ft PROPERTY LINE <br /> DISTANCE TO NEAREST WELL_ R <br /> ft LENGTH DEPTH ---- <br /> ❑ DISPOSAL PONDS WIDTH ---- ft PROPERTY LME ----tt <br /> - <br /> pISTANCETONEARESf WELL ft FOUNDATION It DEPTH R <br /> ❑ SEEPAGE PITS NUMBERW1O� ft <br /> E TO NEAREST WELL <br /> R FOUNDATION R PROPERTY LINE <br /> DISTANC <br /> I HEREBY CERTIFY THAT 1 HAVE <br /> PREPARED <br /> S.STATIS A E LAPPLICATION AND THE WORK WILL RE DONE IN WS AND RULES AND REGULATIONS OF SAN JOAQUIN WITH SAN JOAQIIiN COUNTY <br /> COUNTY- <br /> ORDINANCES, <br /> Mt"iMUM 21 HOUR VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 /� <br /> - G � TITLE �/� -"7 �-=— -DATE '2— <br /> SIGNED o -- <br /> f SIGNED rY��•YYY���-����� <br /> I <br /> I <br /> Q <br /> i <br /> i <br /> I <br /> / <br /> -- - <br /> ' PARTMENiU, AN <br /> < </�=„'[(! �Area Employee IDk <br /> ! `�(�//l� <br /> Apey <br /> ptication Ace pled e c Date <br /> , Date [3 SPECIAL PERMIT-Approved by <br /> 1, Foal Inspection By pit/Sump Soil Character: <br /> Character oI SoH to Depth 3 Ft* <br /> ✓t�Jt !O�- <br /> COMMENTS <br /> 1 <br /> PE SC Received Amount Date a n ee t <br /> � (',od/ INFO B <br /> Cash Remitted SttrvIce Re uest# <br /> ZZ1 61 <br /> ONSITE WASTEWATER PERMIT <br /> 42-02-001 <br /> 12/22/2003 <br />